Nurses from ‘red list’ nations boost NHS register

Unlock the Editor’s Digest for free

Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.

Thousands of nurses from “red list” countries short of health workers have registered to work in the UK in recent months, as the NHS seeks to boost staffing to match demand, the profession’s regulator warned on Thursday.

Under a code of practice set out by the Department of Health and Social Care, employers in the sector should not actively recruit from poor countries with their own shortfall, although they can accept job applications from individuals. 

However, the Nursing and Midwifery Council said its report had found that 3,071 nurses joined the UK-wide nursing and midwifery register from red list countries in the six months to September 30, taking the total to 24,905.

Meanwhile, the number of nurses and midwives registered to work in the UK has hit record levels, with 30,103 joining the register over the same six-month period. A net increase of 19,857 after accounting for leavers, that takes the total eligible to work in the UK to 808,488. 

This was partly because of strong growth in the number of joiners trained in the UK — which the NMC said could reflect the “Chris Whitty effect”, a reference to England’s chief medical officer at the start of the Covid-19 pandemic, when nursing degrees soared in popularity.  

But unions said this surge in recruitment had not made a perceptible difference to the pressures nurses and midwives felt on the frontline, and that the burst of interest in studying nursing had proved shortlived.

The NMC’s register includes nurses working in the private sector and through agencies as well as NHS staff, and would not include all leavers who had quit within the past three years. 

Stuart Tuckwood, national nursing officer at the union Unison, said “the NHS workforce crisis hasn’t gone away”, noting that the number of students starting nursing degrees had dropped 12 per cent in the past year.

Under the NHS Long Term Workforce Plan for England, nursing training places need to rise by 65-80 per cent above last year’s levels to meet 2031 targets. 

“Around half of new nurses are from overseas and without them, the NHS would collapse,” Tuckwood added. 

The UK has become increasingly reliant on nurses from abroad: almost half of new joiners to the nursing register in 2022-23 were educated overseas, mainly outside Europe.

India, which is not a red list country, is the biggest single source of international recruits. But the NMC said its data showed “concerning trends” in the rising numbers joining the UK register from Ghana and Zambia, and the steady inflows from Nigeria — all countries that employers are meant to avoid. 

Miriam Deakin, director of policy and strategy at NHS Providers, which represents frontline health leaders across England, said the rise in joiners from red list countries was a concern. 

“International recruitment must be done ethically,” she said. “The NHS Long Term Workforce Plan aims to drive domestic training alongside international recruitment. For this to be realised, the plan must be adequately funded by the government.”

Professor Nicola Ranger, chief nurse at the Royal College of Nursing, warned that the government’s “over-reliance on unethical international recruitment from red list countries” had become the “norm”.

“It’s a false economy. The government should be investing in nursing staff in the UK, funding nurse education and fair pay — not destabilising other healthcare systems,” she added.

Ruth May, chief nursing officer for England, said she was “thrilled that we now have record numbers of registered nurses”.

“Recognising that we need to go further, the NHS Long Term Workforce Plan commits to doubling the number of adult nurse training placements by 2031,” she added.

The Department of Health and Social Care said there was now a record number of homegrown nurses and doctors in the NHS and that number was increasing.

“Our published Code of Practice is clear that whilst recognising an individual’s right to migrate, organisations should not actively recruit from [World Health Organisation] red list countries,” a department spokesperson said.